Atropine 0.01% combined with orthokeratology slows axial elongation to less than 0.1mm/year over two years in Chinese children aged 6-11 years. This is the equal-longest study on this topic and first to measure potential mechanisms of pupil size and choroidal thickness. The largest effect of the combination occurred in the first 6 months.
The Low-Concentration Atropine for Myopia Progression (LAMP) Study has provided invaluable data on comparisons between 0.05%, 0.025% and 0.01% atropine treatment. The three year data has shown 0.05% to be most effective for continued treatment, while children discontinued showed a small, ‘clinically insignificant’ rebound effect. Learn more about the one, two and three year LAMP data here.
This meta-analysis of 5 studies of 1, 6 and 12 months duration found that slower axial growth is evident when using orthokeratology in conjunction with atropine as a combined therapy compared to orthokeratology alone. A slowing effect of 0.09mm was seen with the combined approach for up to a 12 month follow-up period. Longer data was not available for the meta-analysis.
The Erasmus Medical Group in the Netherlands set out four steps in their myopia management protocol: providing visual environment advice, identifying high-risk myopes by axial length and treating them with atropine 0.5%, managing other myopes with optical treatments or lower-concentration atropine, and ceasing treatment in the late teens once axial length is stable. The described use of axial length percentile growth charts for diagnosis, choice of treatment, monitoring and cessation is a world-first.
This research showed that the concentration of atropine which reaches the retina is 400 times less than by topical administration; and that higher concentrations directly exposed to the mouse retina influence retinal signaling. Whether this is indicates a possible mechanism or unintended impact of atropine, and how this may translate to atropine use in humans, is unknown.
Despite being used for myopia management for many years, significant controversy exists in both literature and clinical optometric practice regarding the optimal concentration of atropine. The LAMP study sheds light on this mystery by investigating efficacy of 0.05%, 0.025% and 0.01% atropine for slowing myopia progression.
Pathologic myopia is one of the major causes of blindness worldwide. Degenerative changes associated with high myopia, including posterior staphyloma formation and scleral thinning, are caused by the progressive elongation of globe axial length and stretching of the sclera, choroid and retina. The aim of this meta-analysis was to investigate and quantitatively define the efficacy of PSR in controlling axial elongation and refraction progression.